Chapter 55: Conjunctivitis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports bilateral burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient’s eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely?

a. Allergic b. Bacterial c. Chemical d. Viral

ANS: A a. Antihistamine-vasoconstrictor drops b. Artificial tears and cool compresses

Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema. Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI.

2. A patient who has symptoms of a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated?

NURSINGTB.COM c. Topical antibiotic eye drops d. Topical corticosteroid drops

ANS: B a. Consider prescribing a topical mast cell stabilizer. b. Determine the duration of treatment with this medication. c. Prescribe a non-sedating oral antihistamine. d. Refer the patient to an ophthalmologist for further care.

Viral conjunctivitis accompanies upper respiratory tract infections and is generally self-limited, lasting 5 to 14 days. Symptomatic treatment is recommended. Antihistamine-vasoconstrictor drops are used for allergic conjunctivitis. Topical antibiotic drops are sometimes used for bacterial conjunctivitis. Topical corticosteroid drops are used for severe inflammation.

3. A patient diagnosed with allergic conjunctivitis and prescribed a topical antihistamine-vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms?

ANS: B

Antibiotic-vasoconstrictor agents can have a rebound effect with worsening symptoms if used longer than 3 to 7 days, so the provider should determine whether this is the cause. Topical mast cell stabilizers are useful as prophylaxis for recurrent or persistent allergic conjunctivitis and results do not occur for several weeks. Oral antihistamines may be the next step if it is determined that the cause of worsening symptoms is related to the allergy. It is not necessary to refer to ophthalmology at this time.

Chapter 56: Corneal Surface Defects and Ocular Surface Foreign Bodies

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner’s next step?

a. Administration of antibiotic eye drops b. Application of topical fluorescein dye c. Instillation of cycloplegic eye drops d. Irrigation of the eye with normal saline

ANS: B

The practitioner must determine if there is a corneal abrasion and will instill fluorescein dye in order to examine the cornea under a Wood’s lamp. Antibiotic eye drops are not indicated as initial treatment. Cycloplegic drops are used occasionally for pain control but should be used with caution. Irrigation of the eye is indicated for chemical burns.

Multiple Response

1. Which patients should be referred immediately to an ophthalmologist after eye injury and initial treatment? (Select all that apply.)

a. A patient who was sprayed by lawn chemicals b. A patient who works in a metal fabrication shop

NURSINGTB.COM c. A patient with a corneal abrasion d. A patient with a full-thickness corneal laceration e. A patient with irritation secondary to wood dust

ANS: A, B, D

Patients with chemical eye injuries, any with possible metallic foreign bodies, and those with full-thickness corneal lacerations must have immediate referral. Corneal abrasions and irritation from wood dust may be managed by primary care providers.